A shared future for medical education

December 18, 2013

By Professor Nick Hawkins, Professor of Pathology and Head of the School of Medical Sciences at the University of New South Wales, Sydney, and Dr Dror Ben-Naim, adjunct lecturer at the School of Computer Science and Engineering at UNSW.

To educate the best doctors and health professionals for twenty-first century, medical schools must collaborate to share access to digital education resources, rather than persist with the competitive models of the past.

This is not a futuristic aspiration. In Australia, the foundations of a world-first collaborative model for medical and allied health education are already in place.With the recent launch of the $4.5 million BEST (Biomedical Education Skills and Training) Network, students studying at member universities have been given access to an unprecedented and growing bank of biomedical images and a catalogue of related digital teaching and learning modules, stored in ‘the cloud’, and shared through the web.

Ensuring every future doctor, from any medical school, has similar instant web access to these powerful learning resources should be a priority for the higher education sector in Australia, and internationally.

Not only is demand rising sharply worldwide for skilled medical and allied health professionals, but clinical practice is becoming increasingly complex due to rapid advances in therapies, medical imaging, biomedical devices and other medical technologies.

Our challenge as educators is to meet that demand as efficiently and effectively as we can.

To understand the benefits of collaboration, we only need look back ten years. Then, every student at every medical school was allocated his or her own precious set of delicate glass slides — usually 100 or so – and access to a microscope.

Every single slide, tens of thousands a year in each medical school, had to be sliced by hand from equally precious tissue samples that represented the major disease processes that every doctor must understand. Such collections were, and still are, an important part of the foundation of knowledge on which medicine is built.

Similarly important is a doctor’s ability to recognise what a disease looks like to the naked eye.

At the University of New South Wales (UNSW) we maintain a Museum of Human Diseases, which exhibits over 3000 specimens of various diseased organs and tissue, preserved in perspex “pots”.

Such samples, removed surgically or obtained during autopsies – some of which are now more than 100 years old – are critical in early medical education.But collections held by individual institutions, no matter how extensive and impressive, have always been limited in scope and access.

In a world where, for example, Google Maps can instantly show us the street view of a house on the other side of the globe, why couldn’t we similarly ‘zoom in’ on the complex, valuable and increasingly hard-to-replace collections of microscopic and macroscopic medical images, wherever they are held in the worldwide?Shouldn’t any lecturer, student or clinician be able to find an image of any condition – say, a rare fracture or a particular allergic reaction – online, and use it in their lecture, for their revision or as a professional reference? Theoretically, yes.

The fine detail in medical images means they are often very large files, which once made them difficult to share and access via the web. But recent advances in cloud storage and faster internet speeds means they can now be pulled down easily using a similar ‘tiling’ system to Google Maps.

This is the starting point for the collaborative model the BEST Network is building. To date, its founding partners – the UNSW, the University of Melbourne, the University of Queensland, James Cook University, and technology partner, Smart Sparrow, along with professional peak bodies – have launched “Slice” – an open, cloud-based, medical image bank, powered by knowledge discovery and sharing tools. These tools let teachers annotate the images, as well as use them in virtual laboratories, online medical cases, and virtual practical classes, on topics ranging from blood typing to snake bite and the diagnosis of urinary tract infections.In developing these resources, we have had the added benefit of partnering with peak professional bodies, including the Royal College of Pathologists, the Australian Orthopaedic Association and the Royal Colleges of Nursing.

Individual universities or medical schools cannot afford to build, maintain and deliver such digital learning capabilities alone. We need to collaborate extensively to deliver the best possible learning resources to as many medical and allied health students as we can.

The advantages are obvious, and the downsides few.

In recent weeks UNSW medical students have, for example, used the BEST Network’s courseware catalogue to review their practical class materials in disciplines as diverse as biochemistry and pathology, by using modules built with the Smart Sparrow adaptive e-learning platform.

The platform, invented at UNSW, makes it easy to build courseware that provides students with a personalised learning experience, in which the content adapts to the pace and level of each individual student.

Back-end learning analytics dashboards give teachers insight into their students’ strengths and weaknesses. Our experience at UNSW tells us that adaptive e-learning tools can improve student outcomes in a way that motivates and enthuses our students.

Universities are accustomed to competing against each other in the rankings, and to promoting their own unique reputation to attract the best students.However, for health care education, we’d like to propose a variation on that model that pools resources for the benefit of all Australian students, while still respecting the individual strengths of each institution.

The BEST Network, initiated through the Commonwealth’s NBN-enable Education and Skills Services Program, provides a template for that future. It’s now up to us to devise a business model, and a way of working together, that can sustain it.

As we speak, plenty of nimble, global technology players are racing into the medical slides and images space, effectively offering to sell universities e-tools to access their own content. Yet this approach will maintain the siloed privacy of those important stores of knowledge.

The BEST Network will create a not-for-profit subscription model, in which member universities invest annually to build, run and maintain our collective resources. In this way, we can achieve our individual goals without putting these valuable educational assets behind institutional or profit-driven firewalls.In fact, we could open them up to clinicians and health students all over the world, positioning Australia as a (collaborative) leader in global biomedical education.